Responsible for processing incoming requests from various departments to bill manual and electronic claims to ensure timely and complete collection of all dollars assigned. The role verifies patient insurance coverage, answers billing questions from internal and external customers, corrects claim edits, follows up on unpaid balances, appeals denials of hospital charges, and manages correspondence, insurance credit balances, over-posted balances, and claims with outstanding balances.
Requirements & Qualifications
Prior hospital billing experience is recommended.
- Compiles attachments, corrects claim edits, updates, and bills claims received from the electronic system
- Submits claims in Epic HB Resolute Billing system
- Documents and updates status of unpaid insurance balances
- Researches billing reference manuals to review billing accuracy
- Processes returned faxes, Certified Return Receipts, production logs, and outgoing mail
- Verifies Medicare, Medicaid, and other third-party eligibility using various systems
- Experience or knowledge of payer web portals, Craneware, Microsoft Office, and Experian claim source clearinghouse portal preferred
- Extensive knowledge of insurance and managed care, including Medicare, Medicaid, Tricare, VA, workers' compensation, and commercial plans
- Working knowledge of CPT-4, HCPCS, ICD-10, revenue codes, and 1500 forms
- Understanding of patient type, financial class, insurance master, place of service codes, relationship codes, and accommodation/occurrence/value/condition codes
- Knowledge of Medicare Secondary Payer rules, medical necessity, reviews, and appeals
- Strong verbal and written communication skills
- Highly organized, self-motivated, and able to prioritize multiple tasks
- Ability to understand EOBs, identify denial issues, and communicate denial trends
- Strong analytical, interpersonal, PC, and data entry skills
- Familiarity with HIPAA privacy requirements
- CPAR certification highly desirable
Benefits & Perks
- Low healthcare insurance premiums
- 401(k) with employer match
- Paid time off (PTO)
- Employee discounts
- Company-paid life insurance
- Short-term and long-term disability
- Cancer insurance
- Accident insurance
- Pet insurance
- Tuition reimbursement
- On-the-job training and skills development
- Opportunities for growth and advancement
- Employee assistance program
Location
Georgia, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
2 months ago